From SIRS to Septic Shock: An Innovative Solution to Surviving Sepsis Utilizing a Nurse Practitioner-led Screen Team

Purpose:
In response to the considerable burden of sepsis-related mortality, the Methodist Hospital (TMH) has developed an innovative approach to reduce morbidity and mortality rates by capitalizing on the efficacy of nurse practitioner-led screening of patients prior to the onset of severe sepsis.

Significance:
Sepsis is the 11th leading cause of death in the U.S. Despite advances in medicine, care and complications related to sepsis mortality have not significantly decreased in 40 years. Furthermore, the correlation between sepsis progression and mortality rates suggest early evaluation is crucial therapy

Strategy and Implementation:
TMH formed an interdisciplinary taskforce to focus on increasing awareness and improving outcomes related to sepsis. A plan for a nurse practitioner (NP)-led sepsis screen team was formulated and acute care nurse practitioners (ACNPs) were specifically selected in order to capitalize on their advanced assessment/diagnostic skills and ability to initiate immediate treatment. The sepsis NP screen team was charged with addressing early sepsis identification and treatment in the non-ICU patient population. An online SIRS screening tool was developed to track data and positive SIRs screens prompted a more in-depth assessment to determine the possibility of sepsis and search for a source of infection. The ACNP then initiates evidence-based, early goal-directed therapy as recommended by the TMH-approved protocol upon sepsis identification. Two pilot floors implemented RN SIRS screening for patients every 12 hours. A positive screen required further assessment by the sepsis NP screen team.

Evaluation:
5,673 screens have been executed by the sepsis NP screen team from October 1, 2009 through May 27, 2011. Sepsis Mortality decreased from 35.73% in 2008 to 18% in 2010. Other acute conditions have also been identified and addressed by the sepsis NP screen team.

Implications for Practice:
Unlike models in other premier hospitals, this innovative program highlights ACNPs ability to promote awareness, increase early recognition, and improve sepsis-related outcomes. Timely evaluation also contributes to cost reduction and improvement in hospital quality indicators.